At a glance
Legal framework
Statute, almost entirely. In Marquis v. Farm Family Mutual Insurance Co. (1993) the Law Court said it would “expressly refuse to recognize an independent tort of bad faith resulting from an insurer’s breach of its duty to act in good faith and deal fairly with an insured”, on the ground that a tort would cut across the comprehensive insurance code the Legislature had already written. So you are left with breach of contract plus two statutes: 24-A M.R.S. § 2436, the prompt-payment section, and 24-A M.R.S. § 2436-A, unfair claims settlement practices.
Can you sue directly?
Yes, but only under § 2436 and § 2436-A. Section 2436-A lets an insured sue its own insurer for five named practices — knowingly misrepresenting facts or policy provisions, failing to acknowledge and review a claim within a reasonable time, threatening to appeal an arbitration award purely to force a cheaper settlement, failing to affirm or deny coverage within a reasonable time after finishing the investigation, and failing without just cause to settle promptly once liability is reasonably clear. The general unfair claims practices section, 24-A M.R.S. § 2164-D, is the opposite: it closes with the words This section may not be construed to create or imply a private cause of action for violation of this section. That one is the Superintendent’s to enforce, not yours. And under Linscott v. State Farm (1977) the duty of good faith “runs only to an insurance company’s insured” — if you are claiming against someone else’s insurer, none of this is available to you.
Deadline
6 years is the working figure. Maine’s general limitation, 14 M.R.S. § 752, gives 6 years for all civil actions unless something else is specially provided, and that covers both suit on the policy and the § 2436 and § 2436-A claims. The trap is not the statute, it is your policy. Maine’s standard fire policy, set out in 24-A M.R.S. § 3002, bars any suit “unless commenced within two years next after inception of the loss”, and the same clause sits in most homeowner and commercial property policies. Proof of loss under that policy is due within 60 days of the loss. Read your own policy before you rely on the six years.
Before you file
None required. Maine has no notice letter, no cure period, no certificate of merit and no mandatory mediation before you sue on either statute. Complaining to the Bureau of Insurance is optional and is not a precondition. But there is one letter worth sending anyway: § 2436(4) makes the insurer liable for your attorney’s fee if overdue benefits are paid after it receives notice that an attorney is representing you. A single written notice of representation puts the fee clock in motion without your filing anything.
What you can recover

Damages available in Maine

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Insurance dispute attorneys — Maine

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How to find one yourself, free

This is the service the Maine Judicial Branch’s own Find Legal Help page points to. It charges a $35 administrative fee, and the lawyer it refers you to will not charge for the first half-hour. We could not verify a current telephone number from an official page — use the web form rather than a number found elsewhere. Maine runs no certified-specialist programme of its own. The Board of Overseers of the Bar regulates and disciplines lawyers and publishes an attorney directory, but it certifies nobody in insurance, coverage or any other field, so there is no official badge to look for. Judge candidates on what they have actually litigated.

Before you sue

How often does your insurer actually pay?

Worth checking before you spend money on a lawyer. Two different measures exist, and they are not interchangeable — one is a real payment record, the other is a complaint count.

Health cover — real denial rates

Published, per insurer

Health insurers selling on the federal marketplace must report how many claims they received and how many they refused. The figures are public and free to inspect.

20%
Average denied, 2023
1%–54%
Range across 175 insurers

The spread is the point. Two insurers selling comparable cover in the same state can refuse wildly different shares of what they are billed for. Look your own up before you assume your refusal was routine.

Source: CMS Transparency in Coverage public use files, plan year 2023 experience. Self-reported by insurers and not audited. Covers federal-marketplace plans only — not employer cover, and not state-run marketplaces. Post-service claims only.

Home, auto & property

No payout rate is published

There is no free public figure showing what share of home or auto claims any named insurer pays. Insurers do report it to regulators, but in most states that filing is confidential. Any table you see online quoting payout percentages for property insurers is either a paid commercial product or an estimate.

What is public is the complaint index — how many confirmed complaints a company generates against its share of the market. 1.00 is average. 3.00 means three times the complaints its size would predict.

Complaint indexes are published by state insurance departments and compiled by the NAIC. Figures move with both the company’s complaints and the wider market’s.

These two numbers are not the same thing. A denial rate is the share of claims an insurer refused. A complaint index is how often customers complained relative to the company’s size. A low complaint index does not mean an insurer pays well, and a high one does not prove it refuses claims — it can reflect the kind of cover it sells or the customers it attracts. Neither figure says anything about whether your claim should have been paid.
The clock

What the insurer is required to do, and by when

Under § 2436(1) a claim is payable within 30 days after the insurer receives proof of loss and ascertains that the claim is valid — 60 days under the standard fire policy, 2 months for individual life insurance. If the insurer asks in writing for more information inside that window, the clock restarts when the information arrives. A claim “neither disputed nor paid within 30 days is overdue”, and interest starts. To dispute it the insurer must send a written statement of the grounds, “based upon a reasonable investigation of the claim” and detailed enough for you to understand and respond. Separately, § 2164-D requires claim forms and an explanation of how to use them within 15 calendar days of a request, acknowledgment of written communications with reasonable promptness, and a coverage decision within a reasonable time after the investigation is finished. Long-term care claims are outside § 2436 entirely.

The thing most people miss

The 18% interest can be switched off with a letter. Section 2436 only charges interest on an undisputed claim, so an insurer that formally disputes your claim in writing — with grounds, based on a reasonable investigation — owes nothing extra no matter how long the fight then takes or how wrong it turns out to be. Maine’s prompt-payment statute punishes silence and drift, not denial. The insurer that says no quickly and in writing is in a far better position than the one that leaves your file on a desk.

Unsettled: Two things are genuinely open. First, no Maine appellate decision squarely fixes the limitation period for a § 2436-A claim; the 6-year general period in 14 M.R.S. § 752 is the natural fit, but an insurer could argue the one-year penal-statute limit in 14 M.R.S. § 858 applies to a statutory remedy of this kind. Do not test it — work to the earliest date. Second, how hard a court will look at an insurer’s written dispute under § 2436(2) is unsettled: the statute demands a reasonable investigation and real detail, but there is little authority on what happens when the stated grounds turn out to be pretextual. Note too that the Maine Unfair Trade Practices Act is probably not a way around any of this — 5 M.R.S. § 208 exempts conduct permitted under laws administered by a state regulatory officer, which is what the Bureau of Insurance is.
Free first step

Complain to the regulator before you spend anything

A complaint to the Maine Bureau of Insurance costs nothing, creates a written record, and sometimes moves a stalled claim on its own. It is not a substitute for legal advice and it does not pause any deadline — but there is rarely a reason not to do it first.

Where this comes from

Sources

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